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Tomaszewski R, Kler J, Pethe K, Zachurzok A. Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures. J Orthop Surg Res 2021; 16:449. [PMID: 34256792 PMCID: PMC8276397 DOI: 10.1186/s13018-021-02463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases. Methods During the years 2013–2020, 6 pediatric patients with OCFs, aged 14–18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods. Results Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2–11) and 9.62% (4.4–24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41–99.44). Conclusion The Anderson-Montesano and Tuli’s classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF.
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Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland. .,Faculty of Science and Technology, Institute of Biomedical Engineering, University of Silesia, Katowice, Poland.
| | - Jacek Kler
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland
| | - Karol Pethe
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland
| | - Agnieszka Zachurzok
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Tomaszewski R, Gap A, Lucyga M, Rutz E, Mayr JM. Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:530. [PMID: 34070410 PMCID: PMC8228604 DOI: 10.3390/medicina57060530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.
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Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Medyków 16, 40-752 Katowice, Poland
| | - Artur Gap
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
| | - Magdalena Lucyga
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Melbourne, VIC 3052, Australia;
| | - Johannes M. Mayr
- Department of Pediatric Surgery, University Children’s Hospital Basel, University of Basel, 4031 Basel, Switzerland
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Utheim NC, Josefsen R, Nakstad PH, Solgaard T, Roise O. Occipital condyle fracture and lower cranial nerve palsy after blunt head trauma - a literature review and case report. J Trauma Manag Outcomes 2015; 9:2. [PMID: 25897322 PMCID: PMC4403883 DOI: 10.1186/s13032-015-0024-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/13/2015] [Indexed: 11/22/2022]
Abstract
Background Lower cranial nerve (IX-XII) palsy is a rare condition with numerous causes, usually non-traumatic. In the literature it has been described only a few times after trauma, mostly accompanied by a fracture of the occipital condyle. Although these types of fractures have rarely been reported one could suspect they have been under-diagnosed. During the past decade they have been seen more frequently, most probably due to increased use of CT- and MRI-scanning. The purpose of this review is to increase the awareness of complications following injuries in the craniocervical region. Methods We based this article on a retrospective review of the medical record of a 24-year old woman admitted to our trauma center after being involved in a car accident and a review of the literature on occipital condyle fractures associated with lower cranial nerve palsy. Results The multitraumatized patient had suffered a dislocated occipital condyle fracture. Months later she was diagnosed with palsy to cranial nerve IX-XII. Literature review shows that occipital condyle fractures are rare as isolated injuries and are in many cases accompanied by further injuries to the cervical spine and soft tissue structures, in many cases ending with severe disability. The exact mechanism leading to these injuries cannot always be explained. Conclusion Recognition of soft tissue injuries in patients with blunt head trauma is important. CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.
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Affiliation(s)
- Nils Christian Utheim
- Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Roger Josefsen
- Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Per Hjalmar Nakstad
- Department of Neuroradiology, Division of Diagnostics and Intervention, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torfinn Solgaard
- Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Olav Roise
- Department of Orthopedics, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Krüger A, Oberkircher L, Frangen T, Ruchholtz S, Kühne C, Junge A. Fractures of the occipital condyle clinical spectrum and course in eight patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 4:49-55. [PMID: 24744561 PMCID: PMC3980555 DOI: 10.4103/0974-8237.128525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs. Materials and Methods: All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years). Results: Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only. Discussion: OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.
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Affiliation(s)
- Antonio Krüger
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Ludwig Oberkircher
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Thomas Frangen
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Christian Kühne
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Andreas Junge
- Department of Trauma and Hand Surgery, Hospital of the Brothers of Mercy, Trier, Germany
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Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery 2014; 60:82-91. [PMID: 23839357 DOI: 10.1227/01.neu.0000430319.32247.7f] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To evaluate the outcomes of patients with occipital condyle fractures (OCFs) treated nonoperatively and establish factors associated with neck disability. SUMMARY OF BACKGROUND DATA The majority of OCFs are treated nonoperatively; however, few studies have reported long-term functional outcomes of these patients. METHODS From 1999 to 2007, 103 patients with OCFs were identified. Of this cohort, 28 patients with 32 fractures met the inclusion criteria. Fracture and patient characteristics, including patient age and sex, Anderson and Montesano fracture type, bilaterality, associated head injury, and fracture displacement, were noted. The Neck Disability Index (NDI) was calculated at final follow-up. RESULTS Anderson and Montesano type III fractures were the most commonly observed (54%), followed by type II (43%). The mean NDI was 14.0, which correlates with mild disability, and the NDI headache question showed the highest mean disability score of all questions. There was no statistically significant association between NDI scores and fracture type, displacement of fracture, sex, bilaterality, or presence of head injury. Age was associated with NDI scores, with age range of 40 to 60 years having a mean NDI score of 24.3. CONCLUSION Anderson and Montessano types I, II, and III OCFs may be treated nonoperatively in the absence of ligamentous instability and concomitant cervical injuries with the expectation of mild neck disability regardless of the displacement, bilaterality, sex, or presence of head injury. Greater disability may be expected in patients aged between 40 and 60 years than in other ages.
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Tee JW, Chan CHP, Gruen RL, Fitzgerald MCB, Liew SM, Cameron PA, Rosenfeld JV. Inception of an Australian spine trauma registry: the minimum dataset. Global Spine J 2012; 2:71-8. [PMID: 24353950 PMCID: PMC3864422 DOI: 10.1055/s-0032-1319772] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 04/24/2012] [Indexed: 12/19/2022] Open
Abstract
Background The establishment of a spine trauma registry collecting both spine column and spinal cord data should improve the evidential basis for clinical decisions. This is a report on the pilot of a spine trauma registry including development of a minimum dataset. Methods A minimum dataset consisting of 56 data items was created using the modified Delphi technique. A pilot study was performed on 104 consecutive spine trauma patients recruited by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Data analysis and collection methodology were reviewed to determine its feasibility. Results Minimum dataset collection aided by a dataset dictionary was uncomplicated (average of 5 minutes per patient). Data analysis revealed three significant findings: (1) a peak in the 40 to 60 years age group; (2) premorbid functional independence in the majority of patients; and (3) significant proportion being on antiplatelet or anticoagulation medications. Of the 141 traumatic spine fractures, the thoracolumbar segment was the most frequent site of injury. Most were neurologically intact (89%). Our study group had satisfactory 6-month patient-reported outcomes. Conclusion The minimum dataset had high completion rates, was practical and feasible to collect. This pilot study is the basis for the development of a spine trauma registry at the Level 1 trauma center.
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Affiliation(s)
- J. W. Tee
- Department of Neurosurgery, The Alfred, Melbourne, Victoria, Australia,Department of Trauma, The Alfred, Melbourne, Victoria, Australia,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - C. H. P. Chan
- Department of Neurosurgery, The Alfred, Melbourne, Victoria, Australia,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - R. L. Gruen
- Department of Trauma, The Alfred, Melbourne, Victoria, Australia,Department of Surgery, Monash University, Melbourne, Victoria, Australia,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - M. C. B. Fitzgerald
- Department of Trauma, The Alfred, Melbourne, Victoria, Australia,Department of Surgery, Monash University, Melbourne, Victoria, Australia,Department of Emergency Medicine, The Alfred, Melbourne, Victoria, Australia
| | - S. M. Liew
- Department of Surgery, Monash University, Melbourne, Victoria, Australia,Department of Orthopaedics, The Alfred, Melbourne, Victoria, Australia
| | - P. A. Cameron
- Department of Emergency Medicine, The Alfred, Melbourne, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J. V. Rosenfeld
- Department of Neurosurgery, The Alfred, Melbourne, Victoria, Australia,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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8
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Taghva A, Hoh DJ, Lauryssen CL. Advances in the management of spinal cord and spinal column injuries. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:105-30. [PMID: 23098709 DOI: 10.1016/b978-0-444-52137-8.00007-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Spinal cord injury (SCI) is a significant public problem, with recent data suggesting that over 1 million people in the U.S.A. alone are affected by paralysis resulting from SCI. Recent advances in prehospital care have improved survival as well as reduced incidence and severity of SCI following spine trauma. Furthermore, increased understanding of the secondary mechanisms of injury following SCI has provided improvements in critical care and acute management in patients suffering from SCI, thus limiting morbidity following injury. In addition, improved technology and biomechanical understanding of the mechanisms of spine trauma have allowed further advances in available techniques for spinal decompression and stabilization. In this chapter we review the most recent data and salient literature regarding SCI and address current controversies, including the use of pharmacological adjuncts in the setting of acute SCI. We will also attempt to provide a reader with basic understanding of the classifications of SCI and spinal column injury. Finally, we review advances in spinal column stabilization including improvements in instrumented fusion and minimally invasive surgery.
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Affiliation(s)
- Alexander Taghva
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA.
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Malham GM, Ackland HM, Jones R, Williamson OD, Varma DK. Occipital condyle fractures: incidence and clinical follow-up at a level 1 trauma centre. Emerg Radiol 2009; 16:291-7. [PMID: 19189141 DOI: 10.1007/s10140-008-0789-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 12/15/2008] [Indexed: 12/01/2022]
Abstract
The purpose of the study was to investigate the incidence, management, and outcomes of occipital condyle fractures at a level 1 trauma center. Blunt trauma patients with occipital condyle fracture admitted to a level 1 trauma center over a 3-year period were identified. Prospective clinical and functional follow-up was undertaken, including further radiographic imaging. The incidence of occipital condyle fracture in patients presenting to our level 1 trauma center was 1.7/1,000 per year. Twenty-four patients were followed up at a mean of 27 months post-injury. There was one case of isolated occipital condyle fracture; all other patients had sustained additional orthopedic, cervical spine, and/or head injury. Seven (29%) patients sustained unilateral Type III avulsion fractures, none of which were isolated injuries. Traumatic brain injury was detected in 46% of study patients, and 42% had cervical spine injury. External halothoracic immobilization was used in 33% of cases. Fracture union with anatomical alignment occurred in 21 patients (88%). No patient had cranial nerve deficit at admission or follow-up. Three patients (12.5%) had moderate to severe neck pain/disability at follow-up, all of whom had sustained multiple injuries. Occipital condyle fractures most frequently occur in conjunction with additional injuries, particularly head and cervical spine injuries. Most cases can be managed successfully nonoperatively. Functional outcome is generally determined by pain and disability related to other injuries, rather than occipital fracture configuration.
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Affiliation(s)
- Gregory M Malham
- Department of Neurosurgery, The Alfred Hospital, Commercial Road, Melbourne, 3004, Australia.
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10
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Dashti R, Ulu MO, Albayram S, Aydin S, Ulusoy L, Hanci M. Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16 Suppl 3:261-4. [PMID: 17180399 PMCID: PMC2148078 DOI: 10.1007/s00586-006-0270-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 10/14/2006] [Accepted: 11/06/2006] [Indexed: 10/23/2022]
Abstract
With the routine use of multi-slice high resolution computed tomography, increasing number of occipital condyle fractures have been reported in the last decade. The authors report a very rare case of bilateral occipital condyle fracture complicated by the fracture of the inferior clivus and discuss the possible mechanisms of injury.
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MESH Headings
- Accidents, Traffic
- Adult
- Atlanto-Axial Joint/diagnostic imaging
- Atlanto-Axial Joint/injuries
- Atlanto-Axial Joint/pathology
- Atlanto-Occipital Joint/diagnostic imaging
- Atlanto-Occipital Joint/injuries
- Atlanto-Occipital Joint/pathology
- Cranial Fossa, Posterior/diagnostic imaging
- Cranial Fossa, Posterior/injuries
- Cranial Fossa, Posterior/pathology
- External Fixators
- Functional Laterality/physiology
- Head Injuries, Closed/diagnostic imaging
- Head Injuries, Closed/pathology
- Head Injuries, Closed/physiopathology
- Humans
- Ligaments/diagnostic imaging
- Ligaments/injuries
- Ligaments/pathology
- Magnetic Resonance Imaging
- Male
- Occipital Bone/diagnostic imaging
- Occipital Bone/injuries
- Occipital Bone/pathology
- Pneumothorax/complications
- Respiratory Distress Syndrome/complications
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/pathology
- Skull Fracture, Basilar/physiopathology
- Subarachnoid Hemorrhage/complications
- Tomography, X-Ray Computed
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Affiliation(s)
- Reza Dashti
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, P.O. Box: 9, Cerrahpasa, Aksaray, 34303, Istanbul, Turkey.
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Abstract
Injuries to the upper cervical spine (C0-C2) play a major role in surgical treatment of traumatic sequelae in the entire cervical spine. Even though the number of such operations has increased in recent years, there are no clear treatment recommendations for most types of cervical spine injuries. In view of the wide range of injury types and the correspondingly large number of treatment options, this review focuses mainly on the following types of injuries: C0 fractures, occipital condyle fractures (OCF), atlanto-occipital dislocation (AOD), atlas fractures, atlantoaxial dislocation (AAD), and axis fractures. Important aspects of the mechanisms of injury, clinical signs and symptoms, diagnostic procedures, and treatment options are discussed. Special emphasis is placed on comparatively reviewing the different treatment options discussed in the literature. A summary in table form is presented at the end of each chapter for quick reference.
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Affiliation(s)
- R Kayser
- Zentrum für spezielle Chirurgie des Bewegungsapparates, Klinik und Hochschulambulanz für Unfall- und Wiederherstellungschirurgie, Charité, Campus Benjamin Franklin, Universitätsmedizin Berlin.
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Maughan PH, Horn EM, Theodore N, Feiz-Erfan I, Sonntag VKH. Avulsion Fracture of the Foramen Magnum Treated with Occiput-to-C1 Fusion: Technical Case Report. Neurosurgery 2005; 57:E600; discussion E600. [PMID: 16145511 DOI: 10.1227/01.neu.0000170989.90325.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
ABSTRACTOBJECTIVE AND IMPORTANCE:A 31-year-old woman presented with an avulsion fracture of the foramen magnum via bilateral occipital condyles with extension through the inferior aspect of the clivus.CLINICAL PRESENTATION:The patient had no neurological deficits and was initially immobilized in a halo brace.INTERVENTION:To preserve rotational motion at C1–C2, we performed an occiput-to-C1 fusion with bilateral C1 lateral mass screws attached with rods to occipital keel screws. Postoperatively, the patient remained neurologically intact. Three-month follow-up imaging revealed no abnormal motion. Follow-up computed tomographic scan showed an intact construct and bony fusion.CONCLUSION:This rare injury, a bony variant of occipitoatlantal dislocation, was successfully treated with a unique occiput-to-C1 fusion.
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Affiliation(s)
- Peter H Maughan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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13
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Payer M, Delavelle J. Bilateral occipital condylar fracture. Case report about successful treatment with SOMI brace. J Clin Neurosci 2004; 11:211-4. [PMID: 14732389 DOI: 10.1016/j.jocn.2003.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment guidelines for occipital condyle fractures (OCFs) are not established. Options for unilateral OCF have been discussed in the literature, but not for bilateral cases. We describe a bilateral OCF type II (according to the Anderson/Montesano classification) in a 30-year-old patient, where immobilisation in a SOMI brace (sternal occipital mandibular immobilisation) was successfully used.
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Affiliation(s)
- M Payer
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland.
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